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General NPI Number Information
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NPI Number | 1902857972
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Entity Type | Organization
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Legal Business Name | 4MD2 PHYSICIAN SERVICES OF NICEVILLE LLC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 2190 HIGHWAY 85 N
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City | NICEVILLE
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State | FL
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Zip | 32578-1045
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Country | US
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Telephone | 850-729-9490
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Fax | 205-437-5998
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Provider Business Mailing Address
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Address Line | PO BOX 88490
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City | CHICAGO
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State | IL
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Zip | 60680-1490
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Country | US
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Telephone | 205-437-6098
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Fax | 205-437-5998
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUY DUWANE HOOPER
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Credential |
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Telephone | 205-437-6098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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